Diagnosis of latent tuberculosis infection (tuberculosis screening) in HIV-uninfected adults
- Madhukar Pai, MD, PhD
Madhukar Pai, MD, PhD
- Professor, Department of Epidemiology, Biostatistics & Occupational Health
- McGill University
- Dick Menzies, MD, MSc
Dick Menzies, MD, MSc
- Professor of Medicine and of Epidemiology & Biostatistics
- Montreal Chest Institute, McGill University
Treatment of individuals with active tuberculosis (TB) is the first priority for tuberculosis control; an important second priority is identification and treatment of individuals with latent tuberculosis infection (LTBI) .
In most individuals, Mycobacterium tuberculosis infection is contained initially by host defenses, and infection remains latent. However, latent infection has the potential to develop into active disease at any time. Identification and treatment of latent tuberculosis infection can reduce the risk of development of disease by as much as 90 percent  and so has potential to protect the health of the individuals as well as the public by reducing the number of potential sources of infection [3,4].
There are two major tests for identification of latent tuberculosis infection: the tuberculin skin test (TST) and the interferon gamma release assay (IGRA) [5,6]. Both tests evaluate cell-mediated immunity.
Use of TST for diagnosis of LTBI in HIV-uninfected patients will be reviewed here. Management of LTBI for patients with HIV or receiving tumor necrosis factor-alpha inhibitors is discussed in detail separately, as are issues related to TB screening in children and treatment of latent tuberculosis infection in HIV-uninfected patients. (See "Treatment of latent tuberculosis infection in HIV-infected adults" and "Latent tuberculosis infection in children" and "Tumor necrosis factor-alpha inhibitors and mycobacterial infections" and "Interferon-gamma release assays for diagnosis of latent tuberculosis infection".)
INDICATIONS FOR TESTING
The goal of testing for latent tuberculosis infection (LTBI) is to identify individuals who are at increased risk for the development of tuberculosis (TB) and therefore would benefit from treatment of LTBI [7,8]. Only those who would benefit from treatment should be tested, so a decision to test presupposes a decision to treat if the test is positive.
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- INDICATIONS FOR TESTING
- Risk of new infection
- Increased risk of reactivation
- - Age
- TUBERCULIN SKIN TEST
- Performing the TST
- Repeat and serial testing
- INTERPRETING THE TST
- Negative tests
- - False-negative tests
- - Treating negative tests
- Positive tests
- - False-positive tests
- - Treating positive tests
- Healthcare workers
- Allergic reactions
- Managing referrals
- REPEAT TST INTERPRETATION
- Booster response
- INTERFERON GAMMA RELEASE ASSAYS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS